Search

Introduction Anorexia nervosa (AN) is characterized by dysregulated eating that leads to chronic malnutrition, which may be responsible for several physical complications, including endocrine alterations, such as hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis. Objectives Several studies have shown a dysregulation of the cortisol awakening response (CAR) in symptomatic AN patients. However, it has not been established if the deranged CAR of underweight AN patients is a primary phenomenon or an alteration secondary to malnutrition. Aims The aim of this study was to explore the salivary CAR in both underweight and weight-restored patients with AN. Methods We recruited 59 women: 18 undernourished AN patients, 15 weight-restored AN women and 26 normal-weight healthy controls. Saliva samples were collected in the morning, immediately after awakening and after 15, 30 and 60 minutes, in order to measure saliva levels of cortisol. Participants filled in the state-trait anxiety inventory (STAI) to test their anxiety levels in the morning of the test. Results Compared to healthy controls, underweight AN patients showed an enhanced CAR whereas the weight recovered patients had a normal CAR. These results were not correlated with levels of anxiety. Conclusions For the first time, our results demonstrate that the deranged CAR found in acute AN patients is not present in weight-restored ones, suggesting that altered activity of the HPA axis of symptomatic AN patients is a state-dependent phenomenon. [ABSTRACT FROM AUTHOR]

Introduction Taste perception is a complex phenomenon modulated by different factors, such as taste receptors and memory brain circuits. The palatability of the food, that activates the central reward pathways, also plays an important role in taste perception. It means that taste is able to influence the choice of food and then eating behaviour. Objectives It is well known that people with anorexia nervosa (AN) have a lower sensitivity to reward stimuli and recent studies suggested that altered function of taste neural circuitry may contribute to restricted eating in AN. Aims The aim of this study was to evaluate, in patients suffering from AN, the activation of brain areas involved in taste perception and in central reward mechanisms to both pleasant and aversive taste stimuli and to correlate gustatory neurocircuitry activity with eating behaviours, temperament measures and/or sensitivity to reward and to punishment. Methods Fifteen underweight female AN patients and sixteen normal-weight healthy women underwent a functional MRI to measure brain areas activation to repeated stimuli of a pleasant taste (sucrose solution), alternated with an aversive taste (bitter solution), and water taste. Results Compared to healthy controls, patients with AN showed a significantly reduced activation of left insula and left dorsolateral prefrontal cortex to sweet stimulus and reduced activation of right parietal cortex to bitter stimulus. Conclusions These results, if confirmed in future studies, may improve our knowledge about the pathophysiological mechanisms of AN. [ABSTRACT FROM AUTHOR]

Introduction Some temperament characteristics of personality seem to be modulated by oxytocin. Patients suffering from eating disorders (EDs) display aberrant personality traits. Objectives and aims We investigated the relationships between plasma oxytocin levels and personality dimensions of patients with anorexia nervosa (AN) and bulimia nervosa (BN) and compared them to those of healthy controls. Methods Plasma oxytocin levels were measured in 23 women with AN, 27 women with BN and 19 healthy controls and assessed their personality traits by means of the Cloninger's Temperament and Character Inventory-Revised (TCI-R). Results AN patients showed plasma levels of the hormone significantly lower than BN and healthy controls. In healthy women, plasma oxytocin levels resulted significantly correlated negatively with novelty seeking scores and positively with both harm avoidance (HA) scores and the attachment subscale scores of the reward dependence: these correlations explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted negatively correlated with HA, whereas no significant correlations emerged in AN patients. Conclusions These findings confirm a dysregulation of oxytocin secretion in AN but not in BN and show, for the first time, that the association of circulating oxytocin to patients’ temperament traits is totally lost in underweight patients with AN and partially lost or even inverted in women with BN. These findings suggest a role of oxytocin in certain deranged behaviours of ED patients, which are influenced by the subjects’ personality traits. [ABSTRACT FROM AUTHOR]

Introduction Stress exposure is a risk factor for both the onset and the maintenance of Eating Disorders (EDs). The attachment theory may provide a framework to explain the relationship between social stress and EDs, since secure attachment promotes the seeking for support in order to help people to face stressful events. The endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, is likely involved in mediating the role of attachment in the subjects’ coping with stressful situations. Objectives and aims We explored cortisol responses to the Trier Social Stress Test (TSST) of patients with EDs in order to evaluate possible associations between subjects’ attachment styles and HPA axis functioning. Methods Twenty-one adult patients with EDs (7 with secure attachment and 14 with insecure attachment) filled in the Experience in Close Relationship (ECR) questionnaire, which assesses the adult attachment style, and were exposed to the TSST. Saliva samples were collected before and after the stress in order to measure cortisol levels. Results As compared to ED patients with secure attachment, those with insecure attachment showed a significant different pattern of the HPA response to the stress test. Discussion Present findings suggest that attachment style may influence the HPA response to stress in patients with EDs and this effect may have relevant implications for the pathophysiology of EDs. [ABSTRACT FROM AUTHOR]

Introduction A role for the hypothalamus-pituitary-adrenal (HPA) axis has been suggested in the pathophysiology of anorexia nervosa (AN) and bulimia nervosa (BN), and childhood trauma experiences have been detected frequently in patients with AN and BN. Since trauma exposure in the childhood may persistently affect HPA axis functioning, we explored HPA axis activity in AN and BN patients with and without childhood trauma history. Objectives and aims We aimed to examine possible associations between childhood traumatic experiences and HPA axis functioning, as assessed by the cortisol awakening response (CAR), in adult patients with AN or BN as compared to adult healthy controls. Methods Saliva samples were collected by 41 patients with symptomatic AN, 32 with symptomatic BN and 45 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma Questionnaire (CTQ), which assesses five specific types of childhood trauma. Results As compared to the control group, the no-maltreated AN patient group exhibited an enhanced CAR whereas the no-maltreated BN patient group showed a similar CAR. On the contrary, both AN and BN patients with a positive history of childhood maltreatment exhibited statistically significant blunted CAR as compared to no-maltreated patients. Moreover, in maltreated ED patients the CAR tended to decrease when the number of trauma types increased. Discussion Present findings confirm a dysregulation of the HPA axis activity in symptomatic patients with AN and BN and suggest a dose-dependent effect of childhood adverse experiences on the CAR of adult ED patients. [ABSTRACT FROM AUTHOR]

Introduction Taste perception is a complex phenomenon modulated by different factors, such as taste receptors and memory brain circuitry. The palatability of the food, that activates central reward pathways, also plays an important role in taste perception. It means that taste is able to influence the choice of food and then the eating behavior. Objectives It's well known that people with anorexia nervosa (AN) have lower sensitivity to reward stimuli and recent studies have shown that altered function of taste neural circuitry may contribute to restricted eating in AN. Aims The aim of this study is to evaluate, in patients suffering from AN, the activation of the brain areas involved in taste perception and in central reward mechanisms to both pleasant and aversive taste stimuli and to correlate gustatory neural circuitry activity with eating behaviors, temperament measures and/or sensitivity to reward and to punishment. Methods 12 underweight AN patients and 12 normal-weight healthy subjects underwent a functional MRI to measure brain areas activation to repeated stimuli of a pleasant taste, a sucrose solution, alternated with an aversive taste, a bitter solution, and a water taste. Results Preliminary results showed, in patients with AN, a dysfunctional activation of brain areas involved in both taste perception and reward mechanisms following both the pleasant and aversive stimulus. Conclusions These results, if confirmed in future analyses, may improve our knowledge about the pathophysiological mechanism of AN. [ABSTRACT FROM AUTHOR]

Introduction Childhood trauma exposure is a risk factor for adult psychopathology in general. The biological mechanisms mediating this increased risk involve the endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, that undergoes trauma-induced functional changes, which may persist later in life. Since an association between stressful life events and the onset/course of anorexia nervosa (AN) or bulimia nervosa (BN) has been demonstrated, a role for the HPA axis in their pathophysiology seems likely. Objectives and Aims The cortisol awakening response (CAR) is a useful method to assess the functioning of HPA axis. Therefore, we conducted an explorative study aiming to examine possible associations between childhood maltreatments and HPA axis functioning, as assessed by the CAR, in adult patients with AN or BN. Methods Saliva samples were collected in 24 patients with acute AN, 22 with acute BN and 31 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma Questionnaire (CTQ), which assesses five specific forms of childhood maltreatment. Results As compared to control group, no-maltreated AN group exhibited an enhanced CAR whereas no-maltreated BN group showed a normal CAR. Moreover, both AN and BN patients with childhood maltreatment exhibited a statistically significant blunted CAR as compared to no-maltreated patients. Discussion Present findings suggest that childhood adverse experiences may affect the CAR in adults with AN or BN and this may represent a functional background of the endogenous stress response system, which may have relevant implications in the pathophysiology of EDs. [ABSTRACT FROM AUTHOR]

Introduction Early life experiences can influence hypotalamus-pituitary-adrenal (HPA) axis regulation and adult attachment styles. Furthermore, several studies showed that in patients with eating disorders (EDs) there is a prevalence of insecure attachment. However, the relationship between adult attachment style, HPA axis functioning and onset of EDs is largely unknown. Objectives and aims In order to evaluate possible associations between attachment styles and HPA axis functioning in EDs, we investigated Cortisol Awakening Response (CAR) in ED patients with different attachment styles. Methods Twenty adult patients with EDs were classified in three groups, according to the Experience in Close Relationship questionnaire (6 with secure attachment, 6 with anxious attachment and 8 with avoidant attachment). Saliva samples were collected at awakening and 15, 30 and 60 minutes after. Results There was a significant difference among the groups in both awakening and post-awakening cortisol concentrations. In particular, compared to secure and avoidant groups, the anxious group exhibited lower cortisol concentrations at awakening and post-awakening with a preservation of the timing of the CAR. Discussion Present findings demonstrate that anxious attachment style is linked to flattened CAR in EDs. This pattern has been associated with other psychiatric disorders. Therefore, attachment style could influence the HPA functioning and it could play, although not specifically, a role in pathophysiology of EDs. [ABSTRACT FROM AUTHOR]

It has been hypothesized that sexual dysfunctions in Anorexia Nervosa (AN) patients should be attributed to the core psychopathology of this disorder rather than being considered as merely complications of underweight and of hormonal changes. The following questionnaires were administered: Eating Disorder Examination Questionnaire (EDE-Q), Identity and Eating Disorders (IDEA), Female Sexual Function Index (FSFI), Attachment Style Questionnaire (ASQ) and Symptom Checklist-90-R (SCL-90-R). In patients sexual desire resulted to be inversely associated with EDE-Q total-score, IDEA total score and discomfort with closeness. [Extracted from the article]

Childhood abuse represents a significant risk factor for the development Eating Disorders (EDs) and it is associated with several alterations of the hypothalamic-pituitary-adrenal axis (HPA). The aim of the present study was to evaluate the effects of Cognitive Behavioral Therapy (CBT) on cortisol levels in patients with EDs with and without a history of abuse. [Extracted from the article]

Introduction Many qualitative studies have been carried out on the personal experience of relatives living with patients affected by Eating Disorders (EDs). However, quantitative studies on strategies adopted by relatives to cope with the disorder are lacking. Objective To develop a questionnaire to specifically assess coping strategies of relatives of people with EDs. Aims To develop and to validate a new instrument, the Family Coping Questionnaire for EDs, which is designed specifically to explore coping strategies adopted by relatives of patients with EDs. Methods The preliminary version of the questionnaire was developed through a multi-step methodology, including analysis of the relevant literature and focus groups. Subsequently, patients with EDs and their relatives were recruited at three Italian University sites and were asked to fill in the pre-final version of the questionnaire. Results The final version of the questionnaire consisted of 32 items, grouped in five subscales according to the Cronbach's alpha analysis. Through the confirmatory factor analysis, the five subscales were grouped in two factors, the problem-oriented and the emotion-focused coping strategies. Conclusion The final version of the questionnaire shows good psychometric properties, and requires a short time to be completed. The five subscales identified correspond to those adopted by relatives of patients with other severe mental disorders, such as schizophrenia and bipolar disorders. Further analyses from the same dataset will be performed to better describe the coping strategies adopted by relatives of patients with EDs and to identify predictors of maladaptive coping strategies. [ABSTRACT FROM AUTHOR]